Characteristics of women-only and mixed-gender drug abuse treatment programs.

Specialized substance abuse treatment programs have been developed for women within the past two decades. This article presents the results of a secondary analysis of a regional database of drug abuse treatment programs that compared the characteristics of women-only (WO) and mixed-gender (MG) programs across three treatment modalities. In general, WO programs differed from MG programs in their policies regarding fees, sources of payment, special populations served, services offered, and treatment capacity, process, and duration. The differences in program characteristics reflect broader societal gender differences, including women's generally lower economic status and primary responsibility for child-rearing.

Matching clients' needs with drug treatment services.

This paper reports results of a study that investigated whether matching drug treatment services with client needs improved outcomes for a sample of 171 clients who participated in community-based drug treatment programs. Clients were initially assessed on multiple problem areas (alcohol use, drug use, medical, psychological, family/social, legal, employment, housing) and on areas of special needs or stated preferences for services (e.g., transportation, child care, language). A 6-month follow-up interview reassessed clients' problems/needs in all areas and collected information on the services received. The results showed that some services significantly improved client outcome for those who had expressed needs for such services. Notably, services meeting the need for vocational training, child care, transportation, and housing showed beneficial effects. A higher level of needs and services matching (defined either by the ratio of services received to services desired, or by the total level of met versus unmet needs in the eight problem areas) significantly predicted longer treatment retention.

Drug-user treatment programs in a large metropolitan area.

This paper discusses the results of a comprehensive survey of one of the largest drug-user treatment systems in the United States--the system in Los Angeles County, California, which contains more than 300 programs, covers over 4,000 square miles, and serves clients from a notably heterogeneous population of almost nine million people. The survey reported on here was distinct from similar surveys in that it provided simultaneously comprehensive and in-depth descriptions of formal treatment programs in a defined local area. The authors believe that this survey is the first local drug-user treatment program survey of its scope and magnitude in the United States.

Predicting drug treatment entry among treatment-seeking individuals.

This study examined factors related to drug treatment program entry among 276 drug abusers seeking treatment referral. Six-month follow-up interviews determined that 171 (62.0%) followed through with the treatment referral. The analyses indicated that treatment-entry and non-entry subjects did not differ in predisposing factors (age, gender, race/ethnicity, education), type of drug use, or years of use. A logistic regression analysis indicated that characteristics at baseline predicting subsequent treatment entry include legal pressure, lower levels of psychological distress and family or social problems, and prior successful treatment experience. Legal coercion was an effective factor promoting treatment entry. Drug abusers having prior successful treatment experience were also more likely to reenter treatment. However, those with more severe problems (drug related and others) seemed less likely to enter treatment, indicating that psychological distress and family problems may undermine motivation to follow through on treatment referral.

Consideration of special populations in the drug treatment system of a large metropolitan area.

This article provides a descriptive overview of the characteristics of a large metropolitan drug treatment system in relation to special populations of substance abusers enrolled in the system and the services provided. The findings are based on self-report responses to a comprehensive survey of 294 drug treatment programs in Los Angeles County. The special populations are grouped by health status, ethnic background, language needs, and gender-related needs. The groups are not mutually exclusive. Survey results indicated a generally high proportion of programs capable of meeting the unique needs of a variety of special population clients and most programs having some mix of special population clients in their current caseload. The types of services offered varied by modality and by special populations being served. Implications for program planning and service delivery include consideration of whether or not to offer specialized programs for unique client types.

Breast cancer survivors: psychosocial concerns and quality of life.

PURPOSE: To describe the psychosocial concerns and quality of life of breast cancer survivors evaluated 2 and 3 years after primary treatment. METHODS: A sample of 139 breast cancer survivors who had been interviewed during the first year after primary treatment participated in a mailed survey at 2 years (N = 69) and 3 years (N = 70) after initial surgery. A random sample of these survivors were also interviewed in person. The mailed questionnaire included standardized instruments to assess quality of life (QL), rehabilitation needs, and psychological distress. Additional survey questions were developed to examine post-surgical recovery, employment and insurance problems, social support, and existential concerns. The in-person interviews expanded on these questions and systematically compared these patients' rehabilitation needs to those which existed at the time of an interview 1 year after surgery. RESULTS: The 2 and 3 year participants in this follow-up study did not differ from each other on their prior assessments with standardized QL instruments during the first year after surgery, nor did they differ from the full study sample of 227 women. The scores on the Profile of Mood States and the Functional Living Index-Cancer were the same for the 2 and 3 year survivor groups and did not differ from the previous assessments at 1 year after initial treatment. The scores on the Cancer Rehabilitation Evaluation System showed a significant decline in Global Quality of Life, Sexual Functioning and Marital Functioning between the 1 year and 3 year evaluations. For the 2 year sample only Sexual Functioning showed a deterioration between the 1 and 2 year evaluations. Using the RAND 36-Item Health Survey 1.0, the breast cancer survivors were compared with patients from the Medical Outcomes Study. The breast cancer survivors demonstrated higher levels of functioning in many dimensions (role functioning, social functioning, pain, and general health) than the patients with chronic medical conditions. In spite of relatively good physical and emotional functioning on this generic measure of health status and quality of life, these breast cancer survivors reported a number of important and severe rehabilitation problems that persisted beyond one year after primary treatment. Especially frequent were problems associated with physical and recreational activities, body image, sexual interest, sexual function, and problems with dating for those who were single. CONCLUSIONS: Breast cancer survivors appear to attain maximum recovery from the physical and psychological trauma of cancer treatment by one year after surgery. A number of aspects of QL and rehabilitation problems worsen after that time. Nevertheless, breast cancer survivors rate their QL more favorably than outpatients with other common medical conditions, and they identify many positive aspects from the cancer experience.

Functional status of long-term breast cancer survivors: demonstrating chronicity.

A sample of 223 breast cancer survivors 16 months to 32 years from their original surgery for breast cancer were surveyed to assess their current physical, psychological, and social functional status. Although general measures of functioning indicated high physical, psychological, and social functional status, measures specific to breast cancer diagnosis and treatment indicated problems and concerns. The chronic nature of the illness was demonstrated by many respondents' continued numbness, pain, swelling, and other physical effects of the surgery; continued thoughts about recurrence and nervousness associated with medical follow-up; and concerns regarding health insurance coverage and the willingness of others to discuss the cancer and its long-term effects. The data revealed that length of survivorship is not necessarily associated with the presence of fewer or lesser concerns about the cancer. Social workers and other health care professionals can help survivors understand and normalize these effects.

Predicting psychosocial risk in patients with breast cancer.

Breast cancer is the most common neoplasm in North American women. The psychosocial impact of breast cancer has been extensively studied, and a number of investigators have attempted to characterize women who are at high risk for increased psychosocial morbidity. Although a detailed interview performed by a professional is the clinical standard for psychosocial assessment, such interviews are usually time-consuming and expensive, and thus are rarely performed. This study was designed to develop a strategy for the rapid identification of newly-diagnosed breast cancer patients at risk for psychosocial morbidity. A sample of 227 newly diagnosed breast cancer patients were interviewed systematically by a clinical social worker and were subsequently classified for risk of psychosocial distress in the year after diagnosis. In addition, these women completed a battery of standardized instruments designed to assess quality of life, rehabilitation needs and psychological distress. A logistic regression procedure was used to examine a wide range of variables for their ability to correctly classify the risk of psychosocial distress in this sample. The final model included the Cancer Rehabilitation Evaluation System (CARES) Psychosocial Summary Scale, the Karnofsky Performance Status score and age as the best predictors of psychosocial risk. Subsequently these three variables were used to construct a clinically usable risk prediction model. Additional research should be performed to validate this predictive model.

Characteristics of women at risk for psychosocial distress in the year after breast cancer.

PURPOSE: To provide a detailed description of rehabilitation problems of women, considered to be low risk and at risk for psychosocial morbidity, diagnosed with stage I and II breast cancer 1 month and 1 year after primary treatment. PATIENTS AND METHODS: A sample of 227 newly diagnosed breast cancer patients were systematically interviewed by a clinical social worker and classified for risk of psychosocial distress in the year after diagnosis. They completed a battery of standardized instruments to assess quality of life (QL), rehabilitation needs, and psychologic distress. The primary QL instrument, the Cancer Rehabilitation Evaluation System (CARES), provides a detailed listing of rehabilitation needs. Descriptive CARES data are presented with comparisons between the two groups. RESULTS: The at-risk women had significantly more problems with greater severity than the low-risk women in all areas (physical, psychosocial, medical interaction, sexual, and marital). While both groups showed improvement over the year following diagnosis, the at-risk group had significantly more problems 1 year later. Many physical problems subside, but problems at the local surgical site, psychologic distress, communication with marital partners, and negative body image are more persistent in the at-risk group 1 year later, while half of both groups continue to have sexual dysfunction. CONCLUSION: The detailed listing of problems provided by the CARES may be helpful to clinicians in their interactions with patients. The need for preventive and early intervention for the at-risk patients is underscored.

Exploring the influence of multiple variables on the relationship of age to quality of life in women with breast cancer.

This paper explores the relationship between age, psychosocial status and quality of life in a community based sample (n = 229) of newly-diagnosed breast cancer patients. A casement display methodology is used to examine the influence of demographic and medical variables on the outcome variables of interest (psychosocial status and quality of life) and their relationship to age. Based on the literature, a positive relationship between age and psychosocial status was predicted, but the relationship between age and quality of life was uncertain. For the whole sample, a weakly positive relationship between age and measures of psychosocial status and quality of life was observed. In the exploratory studies using the casement plots, the positive relationship between age and quality of life was most strong and significant in married women and in women who had received segmental mastectomy. Among sub-groups examined according to marital status and type of surgery, a positive relationship between age, psychosocial status and quality of life was observed only in married women who received segmental mastectomy. Additional preliminary observations were made about the relationship of household income and age to the outcome variables being studied. The casement plot methodology permits the simultaneous evaluation of multiple variables as a preliminary step before hypothesis development and should be considered when complex clinical problems are being evaluated.

Breast conservation versus mastectomy. Is there a difference in psychological adjustment or quality of life in the year after surgery?

Women with a breast cancer diagnosis often are given a choice between breast conservation or mastectomy as the primary treatment for their cancer. Despite the high frequency of this cancer, there is little systemic information about the effect of surgical treatment on the quality of life or psychological adjustment of the patient. In this study, the authors prospectively evaluated quality of life, performance status, and psychological adjustment in 109 women who had primary breast cancer treatment. During the year of follow-up, no statistically significant differences in quality of life, mood disturbance, performance status, or global adjustment were found between the two surgical groups, and both groups of patients improved significantly during the year of observation (P = 0.0001). As was predicted, patients receiving mastectomy reported more difficulties with clothing and body image; however, these results apparently did not affect the assessment of mood or quality of life. The authors conclude that patients receiving breast conservation therapy do not experience significantly better quality of life or mood than patients having mastectomy; however, patients having breast conservation surgery have fewer problems with clothing and body image. Women receiving breast conservation therapy may require more intensive psychosocial intervention in the postoperative period because of the added burden of primary radiation therapy.

Quantitative and qualitative assessment of a case management program for cancer patients.

An oncology social work case management model of intervention is described quantitatively and qualitatively. Sixty-nine newly diagnosed breast cancer patients followed by telephone for one year required 374 hours of the social worker's time in providing reassurance, information, and referral to existing community resources. This process took less than one-half hour per patient per month. Case examples provide insight into the clinical aspects of the social worker's efforts. This telephone-based model was found to be highly effective and cost-efficient in addressing the rehabilitation needs of cancer patients. It also is a generic model that can be used with cancer patients with any disease site or phase of illness.

Rehabilitation needs and breast cancer: the first month after primary therapy.

Breast cancer is the most common neoplasm in occidental women, yet very little information is available about the rehabilitation needs of these patients. This report reviews in detail the physical, psychological, social, and financial problems identified by fifty women during the first month after primary surgical treatment. The most frequently reported problems were physical and psychological. Patients undergoing modified radical mastectomy (MRM) are compared with patients receiving segmental mastectomy and primary radiotherapy (SM). There were few differences between the two surgical treatment groups; however, patients in the MRM group reported more difficulty with clothing and body image, while the SM group had more disruption of recreation and social activities. Information about the rehabilitation problems of patients with this common neoplasm should be helpful to patients and to the members of the health care team who are helping them recover.